Researchers at WashU Medicine have found a significant decline in mammography use among certain groups of women. A recent study, led by Adetunji Toriola, MD, PhD, a professor of surgery and a William H. Danforth Washington University Physician Scholar, analyzed 20 years of mammography data from the Behavioral Risk Factor Surveillance System of the U.S. Centers for Disease Control and Prevention (CDC).
The study of more than 2 million women in the U.S., published in JAMA Network Open, found that mammography rates did not significantly decline in the overall population between 2002 and 2022, but did significantly decline among non-Hispanic white women ages 40 to 49, uninsured women and current smokers. These declines followed a 2009 recommendation against routine screening for women under 50 issued by the U.S. Preventive Services Task Force (USPSTF).
The researchers noted that the reduction in mammography use was consistent with the USPSTF recommendation, which was informed by emerging evidence on the balance of benefits and harms of screening in younger women and emphasized individualized decision-making rather than routine population-wide screening. However, the study identified consistently lower mammography use among women without a regular healthcare practitioner, and the largest decline was among uninsured women. Together, these findings suggest that declines in mammography use reflect both increased responsiveness to screening guidelines and structural constraints to healthcare access.
The study also found that there was no significant decline in mammograms among non-Hispanic Black women, who experience substantially higher breast cancer mortality compared with white women. The researchers suggest that outreach and safety-net programs may have buffered declines in screening among Black women.
Breast cancer remains the most commonly diagnosed cancer and the second leading cause of cancer-related death among women in the U.S., with cases in women under 50 on the rise. The researchers note that declines in screening participation may delay diagnosis, shifting cancers toward more advanced stages at the time of detection. In 2024, the USPSTF updated its guidance to recommend biennial screening for women ages 40 to 74, incorporating updated evidence.
